Category Archives: Healthcare

Leap Into The Awful Unknown

Published / by stevec

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Another Krugman Analysis Of Republican / Trump Healthcare

Hard-core libertarians, for example, don’t believe making health care available to those who need it is a legitimate role of government; letting some citizens go bankrupt and/or die if they get sick is the price of freedom as they define it.

But Republicans have never made that case. Instead, at every stage of this political fight they have claimed to be doing exactly the opposite of what they’re actually doing: covering more people, making health care cheaper, protecting Americans with pre-existing conditions.

We’re not talking about run-of-the-mill spin here; we’re talking about black is white, up is down, dishonesty so raw it’s practically surreal. This isn’t just an assault on health care, it’s an assault on truth itself.

Will this vileness prevail? Your guess is as good as mine about whether Mitch McConnell will hold on to the 50 senators he needs. But the mere possibility that this much cruelty, wrapped in this much fraudulence, might pass is a horrifying indictment of his party.

Healthcare – Numbers Matter

Published / by stevec

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Republican Politicians and Trump are masters at using words to deceive the actual implications of policy actions. No so much with numbers. The house healthcare bill is a good example. In an earlier post I attempted to put in context the pittance of money they were throwing at the problem to justify taking away healthcare for millions of Americans that depend on the ACA – $8 Billion over five years for “High Risk Pools.”

I learned many years ago, while working in the Office of Secretary of Defense for Systems Analysis, that quantifying consequences is critical for laying bare the implications of misleading / self-serving political statements.

Beware of what the Senate Republicans are saying and trying to get through. The Republicans and Trump are attempting to drastically cut Medicaid and make other changes that will take away healthcare for millions of Americans and increase costs for the rest of us. All of this to justify giving a tax break to wealthy people.

Look at the facts and consequences:

  • Roughly 70 million Americans depend on Medicaid.
  • Medicaid’s costs per beneficiary are substantially lower than if covered by private insurance. Specifically, a Kaiser Family Foundation issue brief  sited research results that total healthcare estimated spending would increase nearly 26 percent, from $5,671 per person per year to $7,126, if a typical low-income Medicaid adult were covered by private health insurance for a full year. In addition, total health care spending would increase 37 percent, from $909 per child per year to $1,247, if a low-income Medicaid or CHIP-enrolled child were covered instead by private health insurance for a full year.
  • The Center For Budget And Policy Priorities, in Frequently Asked Questions About Medicaid, reported that “Medicaid’s costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per-beneficiary costs under private employer coverage.”

Medicaid Spending per Beneficiary Has Grown More Slowly Than Private Insurance

  • We are waiting to hear from the CBO on the latest assessment of the Senate bill, but it is almost certain to report that (1) 20 plus million people will lose healthcare coverage provided through Medicaid and other ACA provisions, (2) The insurance industry will get a pass on providing coverage for people with pre-exsiting conditions, (3) the state insurance markets will fail, (4) insurance rates will increase for everyone except perhaps for young adults, and (5) we will continue to have the most inefficient healthcare system in the western world — one that consumes over 20 percent of our 10 trillion dollar economy.

These are the facts but they will not be in the Republican or Presidential statements and press releases.

An Alice Rivlin Quote

Published / by stevec

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This is worth reading. I hope Trump and the Congressional Republicans read it!

How Republicans can save their health care legacy

If some version of the Republican reconciliation bill to repeal and replace the Affordable Care Act (ACA) squeaks through both the Senate and the House after the July 4 recess, it will be the first major health care law created by Republicans without a single Democratic vote.

Republicans who care about the future of their party should ask themselves whether they want their label on an unpopular, cobbled-together bill that satisfies neither conservatives nor moderates and is easy for opponents to demonize. Do Republicans really want to be sole owners of a law that deprives millions of working class Americans of health coverage, risks destabilizing health insurance markets, hands huge tax benefits to extremely wealthy people, and is opposed by virtually all health provider organizations?

More On The Three Legs of Insurance-Based Healthcare

Published / by stevec

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As I have written previously, a single payer system would be less costly and preferred to the ACA or the Republican replacement. But the political reality is not there so we are faced with the alternative, the three legs of insurance-based healthcare. as explained by Krugman: Three Legs Good No Legs Bad.

So the Affordable Care Act went for incrementalism — the so-called three-legged stool.

It starts by requiring that insurers offer the same plans, at the same prices, to everyone, regardless of medical history. This deals with the problem of pre-existing conditions. On its own, however, this would lead to a “death spiral”: healthy people would wait until they got sick to sign up, so those who did sign up would be relatively unhealthy, driving up premiums, which would in turn drive out more healthy people, and so on.

So insurance regulation has to be accompanied by the individual mandate, a requirement that people sign up for insurance, even if they’re currently healthy. And the insurance must meet minimum standards: Buying a cheap policy that barely covers anything is functionally the same as not buying insurance at all.

But what if people can’t afford insurance? The third leg of the stool is subsidies that limit the cost for those with lower incomes. For those with the lowest incomes, the subsidy is 100 percent, and takes the form of an expansion of Medicaid.

So what does Krugman have to say about the Senate bill:

First, they’re dead set on repealing the individual mandate, which is unpopular with healthy people but essential to making the system work for those who need it.

Second, they’re determined to slash subsidies — including making savage cuts to Medicaid — in order to free up money that they can use to cut taxes on the wealthy. The result would be a drastic rise in net premiums for most families.

Finally, we’re now hearing a lot about the Cruz amendment, which would let insurers offer bare-bones plans with minimal coverage and high deductibles. These would be useless to people with pre-existing conditions, who would find themselves segregated into a high-cost market — effectively sawing off the third leg of the stool.

So which parts of their plan would Republicans have to abandon to avoid a huge rise in the number of uninsured? The answer is, all of them.

Republican Cruelty

Published / by stevec

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Another post that is not directly about Trump (but he is one of the tribe and is a clear facilitator). It is about Republican Cruelty. Concerning healthcare, Paul Krugman and Timothy Egan say it best:

Paul Krugamen first: Understanding Republican Cruelty:

So one way to understand this ugly health plan is that Republicans, through their political opportunism and dishonesty, boxed themselves into a position that makes them seem cruel and immoral — because they are.

…this story began with a politically convenient lie — the pretense, going all the way back to Ronald Reagan, that social safety net programs just reward lazy people who don’t want to work. And we all know which people in particular were supposed to be on the take.

Now, this was never true, and in an era of rising inequality and declining traditional industries, some of the biggest beneficiaries of these safety net programs are members of the Trump-supporting white working class. But the modern G.O.P. basically consists of career apparatchiks who live in an intellectual bubble, and those Reagan-era stereotypes still dominate their picture of struggling Americans.

Or to put it another way, Republicans start from a sort of baseline of cruelty toward the less fortunate, of hostility toward anything that protects families against catastrophe.

Timothy Egan also addresses the Cruelty of the healthcare bill, The Blood on a Tax Cut. “The toxic Senate bill is the broadest attach on working Americans by a governing political party in our lifetime.”

There is blood on this tax cut. It’s a simple swap — taking away $700 billion from one class of people to give it to another. That swap would leave 22 million Americans without health care over the next decade, and many of them will die prematurely because they will not see a doctor in time. In turn, those making $875,000 a year would get an average tax cut of about $45,000. Those making $5 million a year would get a break of $250,000.

Taking From The Poor & Giving To The Rich

Published / by stevec

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Trump will sign any healthcare legislation that the Republicans send him. He has no empathy. He does not care.

The republicans likewise have no empathy. They do not care. They are in the pockets of the insurance industry and wealthy. Their healthcare bill is a terrible piece of legislation.

  • It will discriminate against the poor, elderly and sick.
  • I will facilitate a tax break for the wealthy.
  • It will allow insurance to cherry-pick based on pre-exisiting conditions.

Consider this: The administrative costs of government-run Medicare is about 1%. In contrast insurance takes 10 to 20 percent off the top for the task of distributing money to healthcare providers.

This 10 to 20 percent cost is huge given that healthcare is between 1/6th and 1/5th of the national economy (between at least 3 trillion and 3.6 trillion of our 18 trillion dollar economy). By going to a single payer system, and getting the insurance industry out of the money-transfer business, the system would save at least something like $300  to $400 billion annually in pure administrative costs.

$300 to $400 billion looks like a pretty good improvement over the current insurance based system! And it does not include other health policy efficiency improvements like allowing negotiation with big pharmacy for better deals on prescriptions.

Healthcare: I Rest My Case

Published / by stevec

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One of my early posts on healthcare was motivated by Ryan’s Power Point presentation – I took notes, Paul Ryan’s Healthcare Bill. At the time I was shocked. Then the house passed version 2 that was equally bad. This was verified by the Congressional Budget Office Report today and reported on by the Huffington Post.

If passed 23 million Americans will lose their health insurance. In addition the bill discriminates against those who are sick and/or old. An estimate of increased average annual cost for those in their 60’s goes from about $1,700 to about 13,600, and increase of 800 percent!  Justification – take from the poor to give to the rich

I learned tonight, via an interview on public television  (thank you Sen. Dianne Feinstein) that the house bill, version 2, was passed without any hearings. Even worse the Senate has a select committee of republican senators, all male, charged with coming up with an alternative. They also plan no hearings. So much for public input to crafting of a very important piece of legislation.

The Republicans and especially Trump and Ryan are not fit to govern.

Healthcare Again: The Box and Balloon Analogy

Published / by stevec

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Krugman has a good piece on the struggles that Trump and Paul Ryan are having passing health care: The Balloon, the Box and Health Care. They want to let air out of the balloon of federal money spent on healthcare.

The fact is their objective is to reduce federal spending on healthcare and pass the costs onto the states. This will reduce federal spending and accommodate giving the rich a big tax cut. This has obvious distributional effects, a problem that is already serious in the US.

Passing the costs onto states has another another problem. States with a large tax basis may be able, and willing, to cover the additional costs. Poorer states will likely not and many people in poorer states will lose healthcare! This goes beyond exacerbating income distribution. It is inhumane.

The latest proposal to add $8 billion over five years to cover high-risk pools in states is an attempt to provide cover for Representatives scared to vote for the bill. Further the $8 billion is entirely not adequate to cove the cost of the pools. It is like pissing in the Ocean.

Healthcare is not an insurance issue. It is a problem of making sure that people have health services when they need the services. It is not an issue of your wealth or how old or young you are. Provision of health services should not discriminate.

The Trump / Ryan  approach is a policy of screw the poor and help the rich. It is a discriminatory policy.

Healthcare Revisited

Published / by stevec

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Sam Rayburn: “There’s no education in the second kick of the mule” — Trump and Paul Ryan’s learning disability: Eugene Robinson’s Editorial explains. Here are exerts from Robinson’s April 20 Washington Post editorial:

House Republicans are apparently ready for yet another attempt to snatch health insurance away from constituents who need it.

Having failed miserably to win passage of an abomination of a bill — the American Health Care Act — Ryan (R-Wis.) and his minions are back with something even worse. A draft framework being circulated this week would pretend to keep the parts of Obamacare that people like, but allow states to take these benefits away. This is getting silly. What part of “forget it” do Republicans not understand?

… Republicans don’t talk much about the practical reason for moving urgently on health care, which is to set the stage for tax reform: They want to take money now used to subsidize health care for low-income Americans and give it to the wealthy in the form of big tax cuts.

The new proposal [the MacArthur amendment] — is like a parody, as if life-or-death access to health care were fodder for a “Saturday Night Live” sketch.

Nominally, [the amendment] would retain the Essential Health Benefits standard imposed by the ACA, which requires insurance policies to cover eventualities such as hospitalization, maternity and emergency care — basically, all the things you’d ever need health insurance for.

The amendment would also appear to maintain the ACA’s guarantees that anyone could buy health insurance, including those with preexisting conditions, and that parents could keep adult children on their policies until age 26. That all looks fine — but it’s an illusion.

After specifying that these popular provisions will stay, the amendment then gives states the right to snatch them away. [In addition] There would no longer be a prohibition … against charging “high-risk” individuals more — so much more, in fact, that they would potentially be priced out of the market. We would go back to the pre-ACA situation in which serious illness could mean losing a home or filing for bankruptcy.

This may satisfy GOP ideological imperatives — Ayn Rand would be so proud — but it is atrocious policy, even if you put aside considerations such as compassion and community.

Unchanged from last month’s failed bill are provisions that would strip massive amounts of money out of Medicaid, by far the nation’s biggest source of payment for nursing-home care. So Republicans might not want to show their faces anywhere near retirement communities.

The Affordable Care Act changed the way most people in this country think about health care. It did not, however, change the thinking of many House Republicans, who continue to believe individuals should be held financially liable for a genetic predisposition toward diabetes or a random cellular mutation that leads to cancer.

Another abject failure to repeal the ACA would be a terrible political outcome for Republicans. But far worse, looking ahead to the 2018 midterms, would be for Trump to sign this latest monstrosity into law.

Healthcare is a Right

Published / by stevec

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From Congressman John Lewis:

Stephen —

Health care is a right — not a privilege for the wealthy few.

The debate among Obamacare’s opponents last week revolved around how much insurance to take away from the most vulnerable among us, plain and simple. It was an affront to our values, and I’m glad we defeated their bill.

Friday’s outcome protects the right to health care for millions of Americans. It ensures that — at least for now — they can continue to have the peace of mind that having insurance provides.

But this will not be the last we hear from members of Congress who want to rip away health care from tens of millions of Americans, and weaken patient protections for many millions more. We must stay watchful as opponents will surely try to find other ways to chip away at the law.

We’ve fought too hard and for too long to give up now. Add your name with OFA, and commit to staying vigilant for the coming attacks against Obamacare.

I will fight every single attempt to turn a deaf ear, a blind eye, and a cold shoulder to the sick, to our seniors, and to working families. I will fight every day, every hour, every minute, and every second. And you should keep fighting too.

Last week’s triumph only happened because of the millions of Americans like you who stood up and made your voices heard, loud and clear.

We must keep up the momentum and continue to make good trouble for those who would strip away our right to affordable, quality care. Add your name with OFA, and say that you’ll continue to defend this law:

Thank you,

Congressman John Lewis